MUSCULAR IMBALANCES IN ELITE HANDBALL PLAYERS - PRACTICAL
CONSEQUENCES WITH RESPECT TO THE PREVENTION OF INJURIES
Hans-Gerd Pieper, Andreas Krödel, Gerd Quack,
Alfried-Krupp Krankenhaus, Essen, Germany
INTRODUCTION: Muscular imbalances are defined as a disproportion between
muscles which mainly function as stabilizers - the so-called postural muscles - and
those mainly inducing motion, i.e., the phasic muscles (1,4,5,7,13).
When strained excessively, e.g., through exercise, postural muscles will react by a
functional shortening. This shortening process will inevitably result in reflex
inhibition which in turn causes their phasic antagonists and synergists to weaken.
Due to this reflex inhibition, the phasic muscle cannot be strengthened properly,
even though suitable exercises may be carried out, because maximum activation
and thus optimal training are prevented by the shortening of the postural muscles.
This will eventually result in muscular imbalances. (Table 1)
Table 1: Characteristics
influence.
Characteristics
function
fatigue
reaction
reaction to strain
reciprocal influence
of phasic and postural muscles and their reciprocal
Phasic Muscle
motion
more
fast
weakness
cannot be stimulated
maximum due to
reflex inhibition
Postural Muscle
stabilization
less
slow
shortening
reflex inhibition of
phasic antagonists
Any shortening of the iliopsoas muscle, for example, leads to an extension deficit of
the hip joint and thus to an anterior pelvic tilt. The athlete can only stand up straight
by compensating this tilt through a hyperlordosis of the lumbar spine (17) and thus
puts an excessive amount of pressure especially on the lower disks. This particularly in combination with technical faults, overtraining, or wrong use of
training equipment - is likely to result in chronic back pain.
The aim of the present study is to determine whether muscular imbalances can be
found in elite handball players and whether a relationship can be established
between pain syndromes occurring frequently and those muscular imbalances.
MATERIALS AND METHODS: In order to investigate the influence of muscular
imbalances on the development of typical lesions in elite handball players, a total
of 69 athletes (12 female, 57 male) actively competing in the German top division
(1st Bundesliga) were examined orthopedically. This group comprised 27 members
of the German National Handball Team (15 male and 12 female) as well as 42
male professionals.
The physical examination included a general questionnaire about health problems,
as well as a clinical orthopedic examination, the main part of which consisted in the
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application of the "Functional Muscular Diagnostics" (2,9,10,11,13,15) as first
described by JANDA (4).
RESULTS AND DISCUSSION: The results reported here systematically apply only
to the group of male subjects, because of the limited number of female athletes
involved in this study. The results from this latter group will, however, be
considered in the discussion. 37% of the male athletes reported chronic back
problems, and 32% suffered from recurrent shoulder pain. The clinical examination
revealed frequent incidences of muscular shortening and weakness, mainly
occurring in the pelvic region, as well as the shoulder (Tables 2 and 3).
Table 2: Frequency of muscular shortening in 69 elite handball players.
Muscle
males (n = 57)
females (n = 12)
hamstrings
84.2 %
66.6 %
major pectorals
77.2 %
41.7 %
adductors
71.9 %
91.7 %
rectus femoris
71.9 %
91.7 %
iliopsoas
59.6 %
41.7 %
trapezius (desc.)
54.4 %
75.0 %
gastrocnemius
52.6 %
58.3 %
lumbar quadratus
47.4 %
33.3 %
Table 3: Frequency of muscular weakness in 69 elite handball players.
Muscle
males (n = 57)
females (n = 12)
abdominal muscles
77.2 %
83.3 %
rhomboids
68.4 %
83.3 %
gluteal muscles
40.4 %
91.7 %
serratus anterior
24.6 %
25.0 %
erector spinae lumb.
22.8 %
33.3 %
As far as back pain is concerned, handball players exhibiting clinical symptoms
also tend to have more muscular imbalances in the low back - pelvis - hip region as
compared to those not suffering from lumbar problems (Table 4). The typical
distribution of muscular shortening (especially of the hamstrings and the iliopsoas)
and muscular weakness (abdominal and gluteal muscles, erector spinae lumbalis)
can adversely affect the statics of the pelvic region. The resulting hyperlordosis will
be increased by certain training techniques, i.e., the throwing of medicine balls,
which can lead to a segmental instability of the lumbar spine, thus contributing to
chronic back pain.
Table 4: Muscular shortening in male handball players
= 36) back pain.
Muscle
with back pain
hamstrings
90.5 %
rectus femoris
81.0 %
lumbar quadratus
71.4 %
iliopsoas
61.9 %
with (n = 21) and without (n
without back pain
80.6 %
69.4 %
44.4 %
55.6 %
Those handball players suffering from shoulder pain show markedly more muscular
imbalances of the shoulder girdle as compared to those who did not report any
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problems (Table 5). These imbalances might cause faulty throwing technique,
because due to muscular shortness of the major pectoral the amount of scapular
adduction and depression is decreased. The shoulder thus being kept in constant
protraction, the anterior joint capsule and the rotator cuff are subjected to
pathological strain in every throwing motion of the arm, thus causing gleno-humeral
instability and secondary impingement syndrome of the rotator cuff (8).
Table 5: Muscular shortening in male handball players with (n = 18) and without (n
= 39) shoulder pain.
Muscle
with shoulder pain
without shoulder pain
major pectoral
94.4 %
76.9 %
trapezius (desc.)
61.1 %
38.5 %
triceps brachii
38.9 %
25.6 %
Muscular imbalances are to be observed in other athletic disciplines as well. The
distribution of parts of the body affected, as well as the frequency of occurrence
vary depending on the discipline (Tables 6 and 7). In skiing, for example, no
muscular shortening of the gastrocnemius and the adductors is to be found due to
constant use of skiing boots forcing the ankle joint into extension and thus
stretching the muscles (13). In swimmers, on the other hand, the frequency of
pectoral shortening is much lower than that in handball players, probably due to
better and more frequently performed exercises (12).
Table 6: Muscular shortening in different athletic disciplines (12, 14).
Muscle
Swimming (n = 54)
Skiing (n = 8)
hamstrings
94 %
31 %
major pectorals
13 %
adductors
24 %
0%
rectus femoris
96 %
81 %
iliopsoas
98 %
81 %
gastrocnemius
78 %
0%
Table 7: Muscular weakness in different athletic disciplines (12, 14).
Muscle
Swimming (n = 54)
Skiing (n = 8)
abdominal muscles
85 %
75 %
erector spinae lumb.
72 %
vastus medialis
50 %
gluteal muscles
28 %
63 %
Among our subjects, the frequency of muscular shortening and weakness differed
somewhat between men and women in the sense that the latter group showed a
higher frequency of shortening of the adductors, rectus femoris, and trapezius
accompanied by weaker rhomboids and gluteal muscles than the male group. On
the other hand, they exhibit fewer shortenings of major pectorals, iliopsoas,
hamstrings, and lumbar quadratus as compared to male players. There is no
immediate explanation for this finding. Possibly, the group of female athletes is too
small to be representative, but differences in training practices between male and
female teams are definitely also a possibility.
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CONCLUSION: The type and frequency of muscular imbalances found in handball
players as compared to those in other athletic disciplines clearly shows an
interrelation between those imbalances and the occurrence of injuries or chronic
health problems. This conclusion is supported by the observation that in the team
of TuSEM Essen there was a marked increase in training injuries in the 1990/91
season as compared to 1989/90 after systematic stretching and strengthening had
been discontinued. Thus in addition to other factors - technical faults, overtraining,
wrong use of training equipment - they may constitute a major cause for typical
sport-specific lesions in elite handball players. The way to prevent this type of injury
would be to include suitable stretching and strength exercises in the training
program for handball players (3,7,14,15,16). Special exercises for this purpose
have been described (6).
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